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目的:观察肾上腺皮质功能紊乱患者糖皮质激素受体(GR)有无改变,并探讨其改变的临床意义。方法:正常对照组80例,库欣病98例,库欣综合征66例,阿狄森病62例及席汉综合征44例。应用放射配体法检测患者外周血多形核白细胞(PML)的GR的最大结合容量(Bmax)及平衡解离常数(Kd)。同时应用Boyden小室法检测白细胞GR的效应指标——氢化可的松(F)对PML的趋化移动(ChtM)的抑制率(FI)。结果:库欣病、库欣综合征、阿狄森病及席汉综合征GR的Bmax分别为(8 937±2 324)、(9 015±2 538)、(4 103±894:)、(4 088±1 032)位点/细胞;库欣病和库欣综合征均明显高于对照组[(6 921±762)位点/细胞,P<0.01],阿狄森病和席汉综合征患者明显低于对照组(P<0.01)。其效应指标FI也呈现出一致的变化。结论:库欣病及库欣综合征患者PML的GR明显升高,阿狄森病和席汉综合征患者明显降低。库欣病、库欣综合征、阿狄森病及席汉综合征患者GR改变同时均伴效应指标的改变,表明这些疾病GR改变具有临床意义。
Objective: To observe the changes of glucocorticoid receptor (GR) in patients with adrenocortical dysfunction and to explore its clinical significance. Methods: 80 cases of normal control group, 98 cases of Cushing’s disease, 66 cases of Cushing’s syndrome, Addison’s disease in 62 cases and syndrome in 44 cases. The maximum binding capacity (Bmax) and equilibrium dissociation constant (Kd) of GR in patients with peripheral blood polymorphonuclear leukocytes (PML) were measured by radioligand method. At the same time, Boyden chamber method was used to detect the inhibitory rate (FI) of leukocyte GR - cortisol (F) on the chemotactic migration (PML). Results: The Bmax of Cushing’s disease, Cushing’s syndrome, Addison’s disease and the syndrome of Shenshi syndrome were (8 937 ± 2 324), (9 015 ± 2 538), (4 103 ± 8 94), 4 088 ± 1 032) locus / cell; Cushing’s disease and Cushing’s syndrome were significantly higher than those in the control group [(6 921 ± 762) sites / cell, P <0.01] Levy patients was significantly lower than the control group (P <0.01). Its effect indicator FI also showed a consistent change. Conclusion: The PML GR in patients with Cushing’s disease and Cushing’s syndrome is significantly higher than that in patients with Addison’s disease and Shenshan syndrome. Cushing’s disease, Cushing’s syndrome, Addison’s disease and patients with Shear’s syndrome in patients with simultaneous changes in both indicators of GR changes, indicating that these diseases have clinical significance of GR changes.